Petr Vlček

The anatomical relationship between the saphenous nerve and the great saphenous vein

Objective Damage to the saphenous nerve (SN) has been a known complication during varicose vein surgeries. We tested whether a better knowledge of the anatomy of the SN and the great saphenous vein (GSV) can prevent such damage. Methods We conducted a morphological and histological examination on 86 limbs from 43 cadavers in order to analyse the anatomical interrelation between the SN and the GSV in the lower leg and we also measured the distance between the nerve and the vein in a sample of 42 sections from three parts of the lower leg. Results The anatomical relationship between the SN and the GSV is varied and the two structures run close to each other so a better knowledge of their anatomy in itself proved insufficient in preventing damage to the SN. Conclusion However, in the case of endovenous laser therapy and radiofrequency ablation tumescent anaesthesia decreases the risk of damage to the SN.

Overexpression of c-Myb is associated with suppression of distant metastases in colorectal carcinoma

The MYB gene codes for the c-Myb transcription factor maintaining proliferation of colon epithelial progenitors, thus controlling colon development and homeostasis. This gene is overexpressed in early phases of colorectal cancer (CRC) tumorigenesis. The aim of this study was to examine the expression of c-Myb in CRC tissue samples both at the messenger RNA (mRNA) and protein levels and to evaluate their associations with clinicopathological characteristics in a group of 108 CRC patients. Statistically significant negative association was found between the frequency of the c-Myb-positive tumor cells assessed by immunohistochemistry and the presence of distant metastases (p < 0.01) but not tumor differentiation, tumor stage, lymph node involvement, vascular invasion, tumor localization, age, and gender of the patients. Although the c-Myb protein level in the tumor tissue correlated with its mRNA level, no significant association between MYB mRNA and any clinicopathological characteristics was observed. We conclude that albeit overexpression of c-Myb is considered as an important factor contributing to early phases of CRC tumorigenesis, it may later have negative effect on tumor cell dissemination as observed recently in breast cancer as well. Further studies are required to explain the role of c-Myb during formation of CRC distant metastases.

Neovascularization after ischemic conditioning of the stomach and the influence of follow-up neoadjuvant chemotherapy thereon

Introduction Esophagectomy and reconstruction remain the optimal treatment for patients with resectable esophageal cancer. Neovascularization after ischemic conditioning of the stomach before esophagectomy is a laparoscopic procedure which may potentially reduce gastric conduit ischemia. Aim To investigate the influence of ischemic conditioning on neovascularization along the greater curvature of the stomach and to explore the effect of neoadjuvant chemotherapy on neovascularization after ischemic conditioning. Material and methods Staging laparoscopy was performed before the main resection procedure; during this procedure ischemic conditioning was performed. Samples taken from the human stomach were divided into 3 groups: group A – patients after ischemic conditioning with a delay of 30–45 days after left gastric artery (LGA) ligation (n = 4); group B – patients who were undergoing neoadjuvant chemotherapy with a delay of 90–140 days after left gastric artery ligation (n = 4); and control group C – patients without ischemic conditioning (n = 7). Results After ischemic conditioning with a delay of 30–45 days, the count of neovessels along the greater curvature of the stomach increased from 5.4 ±0.7 in the control group to 17.5 ±0.9 in a low-power field of view (LPF) in group A and increased still further on average to 19.8 ±10.4 in group B. Conclusions Left gastric artery ligation only is a sufficient procedure for ischemic conditioning of the stomach. Neovascularization along the greater curvature is a continuous process that depends on delay time. Neoadjuvant therapy has no influence on the effect of neovascularization.

Integrating Physical Education and Geography in elementary education in the Czech Republic and the Republic of Slovenia

ABSTRACT This paper addresses the lack of international knowledge and research in interdisciplinary curriculum development and teaching in the subjects of Physical Education and Geography. The authors analysed and compared elementary school curricular documents from two ex-communist countries, the Czech Republic and the Republic of Slovenia (an ex-socialist Yugoslav republic) to reveal how integration of Physical Education and Geography can be embedded at the policy level. A questionnaire survey among teachers examined how the integration is implemented in practice. The authors present some practical examples to show how Physical Education and Geography integration can be achieved. The findings of the study indicate that while interdisciplinarity is an important policy goal of the educational systems of these two countries, integration is not being implemented in practice.

Proměny tělovýchovných koncepcí a jejich vliv na realizaci obsahu vzdělávání v tělesné výchově

Různe evropske tělovýchovne systemy se v průběhu 19. stoleti transformovaly do povinneho obsahu zakladniho vzdělavani a položily zaklad ceske tělesne výchově. Měnici se spolecensko-politicke hodnoty vsak ovlivňovaly jak vzdělavaci koncepce tělesne výchovy, tak jejich různa pojeti a realizace ve výuce. Výsledkem byly a jsou různe způsoby zachazeni se vzdělavacim obsahem tělesne výchovy. Cilem předložene studie je podat ramcový přehled vývoje skolni tělesne výchovy a seznamit pedagogickou veřejnost s rozdilnými koncepcemi obsahu vzdělavani v tělesne výchově i různými podobami výuky, a to jak v minulosti, tak v aktualnim koncepcnim směřovani dle ramcových vzdělavacich programů. S oporou o empiricke výsledky je diskutovana uspěsnost soucasne vzdělavaci koncepce tělesne výchovy, ktera ma za sebou dvacetilete realizacni obdobi. Konstatujeme, že ocekavane výsledky vzdělavani v tělesne výchově, deklarovane v kurikularnich dokumentech, nejsou odpovidajicim způsobem naplňovany ani uplatňovany. Stěžejni přicinu tohoto stavu nachazime v problemu nizke kongruence mezi výchozimi hodnotami spolecnosti, projektovaným obsahem vzdělavani a realizaci obsahu vzdělavani v pedagogicke praxi.

Decubitus as a Cause of Death even in the 21st Century

Cil: Cilem studie bylo analyzovat výskyt dekubitů u pacientů hospitalizovaných a podstupujicich operaci na 1. chirurgicke klinice u sv. Anny v roce 2015. Metodika: Retrospektivni analýza administrativnich dat z nemocnicniho informacniho systemu a z dat specialniho elektronickeho nastroje (I-hojeni.cz). Použit byl statistický software R, statisticka analýza byla provedena pomoci Pearsonova chi-kvadratu na hladině významnosti 0,05. Výsledky: Z celkoveho poctu 3 937 hospitalizovaných podstoupila větsina operacni výkon (n = 3 431; 86,4 %). Nově se vytvořil dekubitus u 31 pacientů. Průměrný věk pacientů byl 82,6 let, jednalo se větsinou o ženy (18 : 13). Body Mass Index (BMI) byl průměrně 25,37; delka hospitalizace 26,67 dni. Průměrný stupeň dekubitu byl 1,64. Pět pacientů mělo vice než jeden dekubitus. Nejcastěji se vyskytovaly dekubity na patě, nasledně na hýždich a sakru. Nezjistili jsme statisticky významný vztah mezi BMI a vznikem dekubitů (p > 0,05). Věk pacientů a delka hospitalizace statisticky významně souvisely s výskytem dekubitů (p = 0,02493). Zavěr: Přes vsechna preventivni opatřeni vznikaji dekubity u chirurgicky lecených pacientů i ve 21. stoleti a jejich lecba je nakladna a dlouha.

Quality of life after surgery for colonic diverticular disease– another reason for surgery?

Introduction The study is focused on the quality of life of patients affected by colonic diverticular disease (DD). While colonic resection is standard practice in complicated DD, treatment of uncomplicated diverticulitis is not so clear. The aim of this study was to evaluate the quality of life in patients who had undergone colonic resection and who had been treated just with medical therapy. Method This is a prospective, single-centre study. Between December 2009 and December 2014, 29 patients were treated for DD in our ward and were willing to fill in the gastrointestinal quality of life index questionnaire (GIQLI), which was sent them later by mail again, after 3 months and one year. We compared the improvement of the quality of life after the treatment – in conservatively treaded C group and in patients after resection – R group. Results We compared C group (21 patients) with R group (8 patients). After 3 months there was no significant difference in changes of gastrointestinal quality of life. But after one year there was significant improvement in the R group + 25%, whereas the improvement in the C group was just +1%. The average change in total GIQLI score C versus R group was 0.6 vs 22, 7 respectively (p = 0.006). The improvement was due to increments in gastrointestinal symptomatology (–0.3 vs 9.8; p = 0.01), physical functions (–0.7 vs 5.6; p = 0.007), social function (–0.5 vs 2.3; p = 0.05) and treatment (–0.3 vs 1.4; p = 0.004) subdomain. Conclusion Because of significant improvement in quality of life after sigmoid resection in the majority of patients, in contrast to non operated group, avoidance of subsequent episodic attacks should not represent the only reason for surgery. Disclosure of interest None Declared.

The role of c-Myb in response of colon cancer cells to oxidative stress

Transcription factor c-Myb is required for maintenance of progenitor cells in colon epithelium. Deregulation of c-Myb is frequently linked with tumorigenesis. For colorectal carcinomas, high c-Myb expression denotes tumors with poor prognosis. Oxidative stress is closely related to all aspects of cancer, including resistance of tumors to anticancer treatment. Evasion of apoptosis induced by chemotherapeutics is one of the mechanisms by which reactive oxygen species (ROS) exert their tumor-promoting effects. Identification of novel biomarkers predicting the clinical response to pro-oxidant therapies is essential for personalized cancer therapies. We followed molecular mechanisms of the c-Myb-induced chemoresistance of colorectal cancer cells. Cells overexpressing c-Myb displayed higher viability and produced significantly more ROS upon treatment with cisplatin and doxorubicin. We also found the c-Myb-induced upregulation of phospho-MAPKp38. This kinase acts as a key sensor of oxidative stress. Using a panel of p38 inhibitors we identified the MAPKp388 isoform as a key molecule mediating c-Myb-induced chemoresistance. In summary, we discovered a novel function of the c-Myb-p38 signaling in the oxidative stress response induced in colon cancers cells by standard chemotherapeutics. (Supported by grant NT13441/2012 of the Internal Grant Agency of the Ministry of Health, Czech Republic.)